It is time to know
how and what exactly to interpret HIV/AIDS
epidemic in Manipur. Different views have
different logic of its construction for any
purpose or public policy implication. I would
rather say that this phenomenon is a complex
and multi-dimensional phenomenon that has
rapidly become a major health crisis in the
world that emerged in the early 1980s creating
unprecedented challenges to human society in
various dimensions.
Today, the HIV continues to spread across the
globe without its geographical expense causing
huge increase in mortality and morbidity among
children and adults. It was called a dreaded
disease or epidemic which has become an
inexorable and awesome threatening the basic
social institutions at the individual, family
and community level which in turn affect the
economy, development initiatives and other
associated linkages at the national level. As
the epidemic posed a challenge for the health
of society, preventive measures are being
taken for the last one decade or so to capture
the growth of the epidemic within the risk
group and the general population. The first
wave of impact emerged on the infected persons
and their families, partners and those who
take care of them.
It includes the trauma of diagnosis, community
reaction (acceptance, stigma and
discrimination), economic and emotional impact
on their households, and reaction of health
care workers, illness and death. It is seen
that a single AIDS related illness or death
can devastate an entire household, the
structure of the family, economic relations,
social interaction, responsibilities of the
family members. The entire phenomenon of
HIV/AIDS epidemic has taken the shape of a
major global and national public health issue.
How HIV/AIDS is
distributed
According to global report of UNAIDS and WHO,
it has been estimated that by the end of June
2000, over 34.3 million people of the world
were infected with HIV. From among them 33
millions were adults, 15.7 millions were women
and 1.3 million were children less than 15
year of age. From the above estimates, it is
clear that the devastating effects of the
epidemic in our life time and beyond are hard
to visualize.
In the developing countries, the worst hit
areas are the Sub-Saharan countries i.e. 24.5
millions and the South and South-East Asian
countries i.e. 5.6 millions by the end of June
2000. Thailand, India and Myanmar seem to have
high prevalence and epidemic is emerging in
Cambodia, Vietnam, Indonesia, Taiwan,
Singapore and Philippines. This region is the
home of 60% of the world population.
The number of HIV infected people in South and
South-East Asia is difficult to determine as
there is lack of proper surveillance data.
However, by the end of 1997, WHO estimates
that there were 6.0 million people living with
HIV/AIDS in this region. Heterosexual spread
is the main route of transmission in Asia,
although IDU account for a large proportion of
cases, especially in Golden Triangle area.
Thailand, India, Myanmar and Southern China
are worst affected regions. The countries like
Cambodia and Vietnam are vulnerable to HIV
infection as their people are going through
profound social and economic changes. HIV
infection rate in Vietnamese sex workers rose
from 9% to 38% between 1992 and 1994/5. The
epidemic in Myanmar reflect that HIV
prevalence among IDU has been 60-70 % since
1992 and HIV infection among sex workers rose
from 4% to 20% between 1992-96.
In India, several estimates have been made
about the prevalence of HIV/AIDS infection.
From the WHO report 3.5 million people are
infected with HIV and 4980 cases of AIDS had
been reported. However, in North Eastern
States of India with constitute only 31.5
million populations in India had also been
infected by the epidemic, adding another
hardship to jeopardize the region, mainly some
States like Manipur, Nagaland, Mizoram and
Assam.
In Manipur, a State in the North eastern part
of India, the single largest mode of HIV
infection is IDU as opposed to heterosexual
contact which is largest mode of transmission
for rest of India and most other countries.
The relationship between HIV infection and IDU
is clearly established in other part of the
world. In South-West Europe 90% of the IDU are
associated to HIV infection followed by 70% in
Ukraine in 1995-97. In Russian Federation,
61.2% of the total HIV tested was IDU in 1996.
In Thailand, 40% of the HIV infections are IDU
in 1989 which has risen from 1% in 1988 where
in China majority 70% cases of HIV infection
and AIDS were IDU which occurred in Yunam
Province, a border State to Myanmar.
In Manipur, there are approximately
20000-30000 opium users of whom about 15000
are estimated to be using drugs via injection
(Sarkar, et al, 1991). The HIV seropositivity
rate among IDU was 4% in 1991 which increased
considerably to 73% in 1993 (Naik et aI,
1991). Once the HIV is present within the
population of IDU, it can be a source for
other heterosexual and prenatal transmission (Friedmen,
et al, 1993). One study in Manipur, an area
which experienced an explosive spread of HIV
among injecting drug users, has found that
50.70% of injectors have reported to had
sexual experiences within the last 5 years (Sarkar,
et aI, 1993). As the HIV epidemic matures,
transmission from IDU to their wives and sex
partners becomes the important route of
infection among females and children. All the
nine districts of Manipur share a varying
degree of HIV prevalence. The highest is found
in Imphal district with 64.58% as district
percentage.
How do you see this
phenomenon?
Different logics are applied to create
different opinions. In general the North
Eastern States have developed in some respects
such as literacy, IMR, CBR and CDR but these
States are rated as less economically
developed States. Apart from facing many
problems, these States are not free from
HIV/AIDS epidemic. The HIV infection rates
among these states vary considerably. As for
Manipur, Mizoram and Nagaland, it is related
to IDU transmission. To me the phenomena of
high HIV prevalence of HIV/AIDS epidemic in
Manipur State cannot be explained by a
mono-casual explanation but it should be seen
within the framework of social, political,
economic and cultural context of Manipur.
One of the
basic reasons is easy access to drugs because
of drug trafficking across the international
borders with Myanmar and the economic interest
that lies there. The supply and demand factor
of drug i.e. heroin when associated with other
factors gave rise to high prevalence of IDU in
late 1980s and 1990s. The increased in
unemployment along with the lifestyle of the
westernized youths and lack of coordination
among the department to curtail the epidemic
also exaggerate the HIV/AIDS epidemic in the
State. Out of frustration, family problems,
pleasure seeking, IDU as a fashion and the
lack of societal control, intravenous drug use
emerged as a refuge for the restless youth.
Along with this, poor health service, lack of
political will and social unrest lead to
increase in the prevalence of IDU. Apart from
confining only to IDU as HIV/AIDS patients,
now attentions are being reflected towards
general population.
The question here is, what are the means to
understand the ever increasing phenomenon
where Manipur’s demography is 24 only lakhs.
Do we need to create the relevance of HIV/AIDS
epidemic and National Rural Health Mission
2005-2012? A systematic approach is to be
enhanced. The type of health facilities
provided to general population along with
HIV/AIDS patients should be improved by
strengthening Primary Health Care System in
every district. In addition, socialization of
service providers, rehabilitation and
vocational trainings for IDUs need to be taken
care. Any program shall have to be sensitive
to discrimination, stigmatization and
conducive to the cultural environment of the
area.
Moreover, the
nature of preventive, promotion programs on
IDU and HIV/AIDS are needed to look beyond
behavioral modifications. Proper surveillance
of the infected persons as well as small time
drug peddlers is needed to be check. Larger
community and family participation is also
still demanding. Above all, the coordination
of Government agencies, NGOs and community is
still lacking. |
